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Semin Thromb Hemost 2023; 49(07): 688-701
DOI: 10.1055/s-0042-1757899
Review Article

Predictors of Recurrent Venous Thromboembolism or Arterial Thrombotic Events during and after Anticoagulation for a First Venous Thromboembolism

Steve Raoul Noumegni
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Cécile Tromeur
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Clément Hoffmann
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Raphael Le Mao
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Emmanuelle Le Moigne
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Claire de Moreuil
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Vincent Mansourati
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
3   Department of Cardiology, Brest Teaching Hospital, Brest, France
,
Bahaa Nasr
4   Department of Vascular Surgery, Brest Teaching Hospital, Brest, France
,
Jean-Christophe Gentric
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
5   Department of Neuroradiology, Brest Teaching Hospital, Brest, France
,
Marie Guegan
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Elise Poulhazan
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Luc Bressollette
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Karine Lacut
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
,
Romain Didier
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
3   Department of Cardiology, Brest Teaching Hospital, Brest, France
,
Francis Couturaud
1   Department of Internal Medicine, Vascular Medicine and Pneumology, Brest Teaching Hospital, Brest, France
2   Inserm, UMR 1304 (GETBO), Western Brittany Thrombosis Study Group, Western Brittany University, Brest, France
› Author Affiliations Funding The study was supported by grants from the “Programme Hospitalier de Recherche Clinique” (French Department of Health), the Foundation “Archipel Santé,” and the sponsor was the Brest Teaching Hospital. The funding source was not involved in designing or conducting the study; collecting, managing, analyzing, or interpreting the data; preparing, reviewing, or approving the manuscript; or deciding to submit this for publication. An academic steering committee led by F.C. assumed overall responsibility for all these steps.
› Further Information
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Abstract

After first episodes of venous thromboembolism (VTE), patients are at increased risk of recurrent VTE and arterial thrombotic events (ATE) compared with the general population, two disorders that are influenced by anticoagulation. However, risk factors of these conditions occurring during and after anticoagulation are little described. Using cause-specific hazard regression models, we aimed to determine risk factors of the composite outcome recurrent VTE/ATE, and separately recurrent VTE or ATE, during and after anticoagulation in patients with first episodes of VTE from a prospective cohort. Hazard ratios (HRs) are given with 95% confidence intervals (CIs). A total of 2,011 patients treated for at least 3 months were included. A total of 647 patients had recurrent VTE/ATE (incidence: 4.69% per patient-years) during overall follow-up (median: 92 months). Of these events, 173 occurred during anticoagulation (incidence: 3.67% per patient-years). Among patients free of events at the end of anticoagulation, 801 had a post-anticoagulation follow-up ≥3 months; and 95 had recurrent VTE/ATE (incidence: 1.27% per patient-years). After adjustment for confounders, cancer-associated VTE (HR: 2.64, 95% CI: 1.70–4.11) and unprovoked VTE (HR: 1.95, 95% CI: 1.35–2.81) were the identified risk factors of recurrent VTE/ATE during anticoagulation (vs. transient risk factor–related VTE). Risk factors of recurrent VTE/ATE after anticoagulation included 50 to 65 years of age (vs. < 50, HR: 1.99, 95% CI: 1.04–3.81), older than 65 years (vs. < 50, HR: 5.28, 95% CI: 3.03–9.21), and unprovoked VTE (vs. transient risk factor–related VTE, HR: 2.06, 95% CI: 1.27–3.34). Cancer-associated VTE and unprovoked VTE are the main risk factors of recurrent VTE/ATE during anticoagulation, while older age and unprovoked VTE mainly predict the risk of these events after anticoagulation.

Keywords

recurrent venous thromboembolism - arterial thrombotic event - risk factor - predictor - prospective cohort

Ethical Approval and Consent to Participate

The study was approved by the Brest Scientific and Ethical Board (Brest Personal Protection Committee), with the last amendment approved on November 20, 2013, under reference number: EDITH II/RB 05.003. Administrative approvals were also obtained from authorities of the Brest Teaching Hospital. All participants signed the consent form.


Availability of Data and Materials

The data that support the findings of this study are available from S.R.N. or F.C., upon reasonable request.


Author's Contributions

Conception and design: S.R.N., F.C., L.B., R.D.; acquisition of data: E.P.; data analysis: S.R.N.; analysis and interpretation of data: S.R.N., F.C., L.B.; manuscript drafting: S.R.N.; manuscript revision: all authors; approved the final version of the manuscript: all authors; obtaining funding: F.C.; administrative, technical, and material support: F.C., C.T., R.D.; study supervision: F.C.; full access to all the data of the study: F.C., S.R.N.; responsibility for all aspects of the study, reliability, and freedom from bias of the data presented: all authors.


Supplementary Material



Publication History

Article published online:
17 October 2022

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